Please input the patient's sex... MALE FEMALE
Ms. Miss Mr. Mrs.

First name.. Last name..

Date of Examination...
Side of Dominance..Right Handed Left Handed

		Left Side Muscle testing			Right Side Muscle testing
Psoas Major / Iliacus
Quadriceps Femoris
Obturators/ Quad Femoris
		Left Side Muscle testing			Right Side Muscle testing
Gluteus Minimus Tensor Fascia Lata
Tensor Fascia Lata
Gluteus Medius
Gluteus Maximus
		Left Side Muscle testing			Right Side Muscle testing
Biceps Femoris
Semitendinosus Semimembranosus
Adductor Pectinus/ Gracilis
		Left Side Muscle testing			Right Side Muscle testing
Tibialis Anterior
Extensor Hallucis Longus